Ms. Small has sustained a brain attack (stroke/CVA). The nurse notes that the patient is having difficulty placing her affected leg in the correct
... [Show More] position when ambulating. This is most likely due to which of the following?
A. Poor directions given to the patient by the physical therapist
B. The patient's lack of proprioception
C. Impaired blood flow to the affected leg
D. The patient's resistance to therapy correct answer: B. The patient's lack of proprioception
Mr. Arbor complains to the nurse that he is feeling anxious. He states, "I'm just so tired of all these tests they are doing, and it's so noisy here at night." Mr. Arbor's pulse is 110 beats/min, and his blood pressure is 140/70 mm Hg. Nursing actions should include which of the following to address his sensory status?
A. Turn on the television or radio in his room so it will distract him.
B. Have the therapist ambulate the patient so he can walk off his anxiety.
C. Close the blinds, dim the lights, and ask the patient what other measures would help him rest.
D. Call the physician and obtain an order for an anti-anxiety medication for prn use. correct answer: C. Close the blinds, dim the lights, and ask the patient what other measures would help him rest.
Timothy is hospitalized and in a coma following a traumatic brain injury. Nursing care would include which of the following?
A. Identify yourself when you enter the room and tell him the day and time
B. Tape his eyelids closed securely to prevent the drying of the corneas.
C. Limit the family's involvement in care so there is more consistency.
D. Avoid touching the patient, because this will increase his irritability. correct answer: A. Identify yourself when you enter the room and tell him the day and time
Cleaning a patient's hearing aid is a nursing action that will have a positive effect on a sensory deficit.
(T or F) correct answer: True
anosmia correct answer: loss of smell
Loss of hearing can put a patient at risk for social isolation.
(T or F) correct answer: True
A patient must place his hand on the wall to keep his balance when walking. He leans when sitting and has difficulty knowing when his body is vertical and sensing the position of his body in space. Which type of receptor is probably involved? [Show Less]